arkansas ppt (health insurance exchanges)

7/27/2019 Arkansas PPT (Health Insurance Exchanges)

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Federally-facilitated Exchange

Partnership Planning in Arkansas:

Where Weve Been; Where We Are Now; andLessons Learned

Cynthia Crone, APNArkansas Insurance Department

Presented to

Idaho Health Insurance ExchangeWorking GroupOctober 9, 2012


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Low Per Capita Income

Poor Health Status Indicators

Large and Growing Percentage of Uninsured

Medicaid Deficit Expected in 2013

Health Agency Leaders Working Together toImprove Health System

Arkansas Landscape


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Arkansas Health System Improvements

Payment and Quality Transformation using Evidence-Based Episodes of Care PCMC Model

Workforce

Health Information Technology

Health Benefits Exchange


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ACA and Arkansas Political Landscape

Popular Governor

Democrats are Majority in Legislature, Growing Number

of Republicans

Vocal, Active TEA Party Republicans Opposed to ACA

and therefore to Exchanges


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Exchange Planning

Arkansas Insurance Department is Lead Agency

Commissioner is Governor Appointee andPlanning Authority

Funding to Date

Exchange Planning

Level One Cooperative Agreements (2)


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How Many Will Be Affected?

An estimated 572,000 Arkansans will be eligible forExchange coverage beginning January 1, 2014.

It is conservatively estimated that: 328,000 more nonelderly Arkansans will enroll (resulting

in a 60% decrease in uninsured post-ACA). There will be a $615 million reduction in uncompensated

care among nonelderly (a 68% change post ACA). There will be $478 million in federal subsidies provided for

Arkansans to purchase insurance.

Source: State Progress Toward Health Reform Implementation: Slower Moving StatesHave Much to Gain, Timely Analysis of Immediate Health Policy Issues, January 2012Urban Institute analysis, HIPSM


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As Is (Pre-ACA)(ACHI, 2012)


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2014 (Post ACA)(ACHI, 2012)


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Development of Partnership Model

Arkansas did not obtain authority for State Exchange - 2011

Arkansas did not seek Level One funding - September - 2011

Partnership Option Announced by CCIIO - September 2011

Exchange Planning Steering Committee recommended thatplanning for a State Exchange end - November 2011

Obtained Governors approval to explore Partnership Modeland apply for Level One Funding - December, 2011


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Arkansas is Planning

Full Partnership Model

Plan Management

Consumer Assistance

MedicaidFFE Integration


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Level One Funding and Waiting

First Level One funding award received February2012

Required to obtain Legislative Approval for Spending

While waiting Exchange Planning Grant No Cost Extension kept small staff

operating

Designed Stakeholder Engagement Process

Designed Contractor/Staff Communication Process Implemented Advanced Procurement and Hiring Activities

Level One Appropriation obtained April 20, 2012


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Stakeholder InclusionOperational Model

Planning Staff &

AdvisoryCommittees

Research /

Alternatives

Analysis

Steering Committee

FinalRecommendation

to Commissioner

Advisory Committees

DevelopRecommendations

with Alternatives


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Steering Committee

The Steering Committee meets once monthly and includes

representation of the following:

Insurance Department (2)

Department of Human Services (2)

Arkansas Health Agency Leaders

Department of Finance & Administration

Advisory Committee CoChairs (6)

State Legislature (2)

Governors Office

Stakeholders At Large (3)


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Topic Calendars

OctMay June July August Sept

Essential

Health

Benefits

Active Purchaser

vs. Open Market

Active Purchaser

vs. Open Market

Network

Adequacy,

Market

Standard andRisk Pool

Definition

QHP Elements

Application

Submission and

Transmission ofData Elements

QHP

Application &

Certification

Format andContent

OctMay June July August Sept

IPA EligibilityIPA Certification

& Recertification

IPA Training

Options

IPA Application

& Application

Review

IPA Program

Funding

IPAPerformance

Metrics

Nov

IPA Ongoing

Monitoring


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Consumer Assistance

In-Person Assisters (IPAs)

Categories

- Navigators

- Enrollment Assisters

- Licensed agents and brokers (producers)

Arkansas Insurance Department will:

- Certify, recertify, decertify individual IPAs

- Oversee IPA training and performance

- Contract with IPA entities to facilitate enrollment and post-

enrollment complaint resolution as needed


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Consumer Assistance

Outreach and Education

Outreach Education

Two Phases Planned for 2012-2013

Phase IGeneral ACA/Exchange Education

Phase IIMove Eligible Residents toward Enrollment

IPA Specialists through Home Town Health

Complaint Resolution

FFE Eligibility/Enrollment AID Consumer Services Division


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Current Outreach/Education - Phase I

Interagency ContractsUAMS

Opinion Poll to guide messaging for Phase I

Focus Groups to assist with Naming/Branding

Speakers Bureau

Initial Message Development/Media Buys

U of A Partners for Inclusive Communities

County Meetings Quarterly Updates

Stakeholder Summit

Staff/Consultants - IPA Outreach


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In Person Assister (IPA) Entities

AID will contract with community-based IPA entitiesthat will engage certified IPAs

We estimate 535 IPAs needed for initial Open

Enrollment decreasing to 134 until next Open

Enrollment

Continuous, real-time feedback from the FFE will becritical in continuously assessing our successes and

initiating needed improvements.


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Key Dates and Benchmarks

In-Person Assisters

IPA IT vendor selection

IPA Program and Processes Defined by December2012

IPA RFP Complete by January 2013 IPA RFP Advertised by February 2013

IPA Awards by May 2013

IPA Training by June 2013 Certified IPAs in the Field July 2013

Open Enrollment October 2013


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Plan Management Activities

Select EHB Benchmark Plan

Define QHP Certification Criteria and Processes

Decrease financial start up risks for issuers

- Risk Adjustment

- Reinsurance (temporary) - Risk Corridor (temporary)


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Plan Management Processes

Leverage Existing Processes within AID wherethey exist:

Life and Health

Rate Review Consumer Services

Finance

License Legal

Use Enhanced SERFF System


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EHB Benchmark Considerations

Compliance with ACA

Consumer Protection

Arkansas Health Needs

Overall Premium Costs and Value

State Mandated Benefits

Wellness Benefits Other


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EHB Benchmark

Rule 103 Directive 2-2012

Arkansas Blue Cross Blue Shield Health Advantage

(POS) with following Substitutions:

QualChoice Federal Plan Mental Health and Substance

Abuse Treatment Services ARKids First (CHIP) Pediatric Dental

Blue Cross Blue Shield Federal Plan (Blue Vision High) for

Pediatric Vision

Habilitative Services will likely be determined by

carriers with State oversight


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Selected Arkansas QHP Certification Criteria

Meet ACA Standards for Benefits and Actuarial Value

Increase Competition in Marketplace Arkansas Specifics:

Will use a certification approach for plan selection.

Will not require network adequacy or quality standards that

exceed federal ACA requirements in year one.

The Steering Committee acknowledges the emerging

importance of Arkansass Payment Improvement Initiative in

advancing quality and affordability and the Exchange may

engage or require carriers to adopt specific qualityimprovement strategies as a condition of having their QHPs

certified to be marketed and sold on the Exchange.


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Selected Arkansas QHP Certification Criteria

Will not require carriers to offer their QHPs statewide as a

condition of Exchange certification in year one, butrecommends consideration of a regional approach with

the goal of statewide coverage.*

Arkansas may limit the number of plans or benefit designsthat may be offered by a carrier on the exchange.*

Pass on options related to incentivizing carriers.

* Steering Committee recommended changes from PMAC recommendation.


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Expected Rules

Network Adequacy

QHP Certification

In Person Assister Certification

More


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Medicaid-Exchange Integration


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Continuous Coverage Across

Insurance Affordability Programs

How to mitigate negative effects of churning or

family members in different plans

Plan to study options using data that evaluates

costs and quality by benefit design, consumerdemand, and provider capacity, to include:

Current FFS

QHP Option Medicaid Plan Option

Bridge Plan


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Summary of Exchange Planning to Date

Planning GrantBackground Research;

Administrative Supplement to do Carrier Survey and

more Quality Definitions

Level One AContractors and Staff to begin serious

Plan Management and Consumer AssistancePlanning

Level One BPrepare for October 1, 2013 Open

Enrollment and Full Implementation of Partnership

Model by January 1, 2014; Study options to mitigate

negative effects of IAP churning and promote

continuity of coverage.


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Key Milestones Planning ReviewMay, 2012

On Track; Big Take Away was that Partnership States would

not issue Navigator Grants

Long-term financial sustainability model for FFE-P unknown

Design ReviewOctober 1-2, 2012

CCIIO/CMS staff very helpful; Arkansas waived out of mostBlueprint items for Partnership Model

Federal officials willing to negotiate implementation issues

with state; Long-term financial issues for FFE-P not

completely resolved, but state must be paid for service

Blueprint Application and Declaration Letter

November 16, 2012

Think about long- term plans

Collaborate with other states


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Key Milestones

QHP and Navigator Certification and Operational

Processes Design Complete by end of 2012

DHHS Conditional Approval as Partnership FFE byJanuary 1, 2013

Implementation ReviewSummer 2013

Open Enrollment October 1, 2013 and Partnership

Exchange is Fully Operational Covering Consumers byJanuary 1, 2014

The Future??


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Advance Planning for Hiring and Procurement

Carefully Plan Stakeholder Engagement Model;

Attract Diverse and Strong Leaders

Integrate Contractors into Planning and

Project Management

Utilize CCIIO Staff and Other Resources

Integrate with Other Health Improvement

Initiatives Be Persistent in Relationship Building


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Keep on message:

Arkansas will not have a State Exchange

FFE Partnership provides Arkansas:

Ability to meet ACA deadlines for compliancewith law

Opportunity to tailor Plan Management and

Consumer Assistance components to meet

needs of Arkansans Local design and implementation of Consumer

Services and Protections

Funding for connecting with FFE

Building Consensus


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Partnership with Medicaid Agency is critical

Consider and document majority and minority

opinions

Make decisions Move on

Keep consumer focus


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Summary

Arkansas has a tremendous need for coverage expansion. Cost, quality, and access improvements in Arkansass

healthcare system will benefit all Arkansans.

The Partnership Exchange allows Arkansas Insurance

Department to continue regulatory and consumer protectionfunctions for our residents.

Intentional efforts to mitigate negative effects of churning and

promote continuous coverage will be especially important

with our population. Transparency and inclusivity in planning is critical.

Keep consumer focus a priority.


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Questions/Comments

[email protected]

5016833634

www.hbe.arkansas.gov
mailto:[email protected]://www.hbe.arkansas.gov/http://www.hbe.arkansas.gov/mailto:[email protected]:[email protected]:[email protected]:[email protected]

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